Health System Factors Associated With Correct use of Artemether-Lumefantrine for Management of Uncomplicated Malaria in Rural Tanzania

Abstract

Poor adherence to and inappropriate use of antimalarials leads to ineffective cure and promote development of drug resistance. We assessed quality of malaria case management in two areas with health and demographic surveillance systems in rural Tanzania to ascertain health worker and facility factors that influence correct prescription and correct dosing of an artemisinin based combination therapy (ACT); Artemether-Lumefantrine (ALu). Exit interviews were conducted to all patients attending for initial illness consultation at health facilities. We collected information about health worker’s training, supervision visits and inventoried facility capacity and availability of medical products related to care of malaria patients. Data were double entered in EPI data and analyzed in STATA version 10 We used logistic regression to assess association of different health system factors to correct use of ALu. The outcomes variables were correct treatment, correct dosing and receiving counselling messages, and the predictors were a range of health worker, health facility and patient factors. Total of 1471 patients were included in this analysis. Majority of patients were seen in dispensaries 70.5 %; (95% confidence interval (95%CI): 57.6-80.8) and in public health facilities 80.2% (95%CI: 72.4-86.1). Work experience seems to be a significant predictor of health workers’ compliance to treatment recommendation. Availability of medical products at health facility and patient characteristics are shown to influence correct use of treatment recommendations. The need to develop targeted interventions to address health system bottlenecks that affect quality of care; such as in-availability of medical products is becoming more apparent